HomeMy WebLinkAboutSeptic New 800 Pleasant Valley Road TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Applicatio�No.
TO THE BUILDING DEPARTMENT: Date 19_�
A permit is requested for repair or construction of an individual sewage dis osal system concerning which the
following information is submitted:
R;&4 1. Owner of Property Address of Owner 00
S.w
2. Location of Property d Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or P,grrsons to Occupy Premises_
5. Plumbing Fixtures: Water Closets / Urinals _ Lavatories Bathtubs
Showers_ Kitchen Sinks / Laundry Tubs_ Garbage Grinder Othe
6. Liquid Capacity of Septic Tan 00 O 42W Material of Septic Tank C^j
7. Soil Conditions: Type of Soil +'- Maximum ground water table d
(Band,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment
10. Percolation Tests: Time for 1" drop in soil test 20 ed,&< - Classification of soil lT
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length Width Total
Other
Signature .
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed,inspected and Approved 19 By
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I HEREBY CERTIFY THIS MAP TO 11"m�p
BE SUBSTANTIALLY CORRECT. AND �cowH''�•e
IN ACCORDANCE WITH CLASS q-2 , ��,�. J. cAR�-�-�';'•.�
CODE OF CONN. TECHNICAL COUNCIL INC.
` 3 �No. 5032 2/1;
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BASE MAP - PROPOSED PROPERTY DIVISIONING OF MR B MRS ROLAND AUBIN,
PLEASANT VALLEY ROAD, SOUTH WINDSOR,CONN. R.M.A, 5- 6 - 67 _
SCALE 1" = 20'— 0 ASSUMED DATUM
PROPERTY OF
ROLAND M. AUBIN ET AL
PLEASANT VALLEY ROAD SOUTH WINDSOR
SCALE 1 " = 201 JULY 1967
ONE FOOT CONTOUR INTERVAL
WILLIAM J. CARRINGTON REG L.S.